Papers - ENATSU Rei

How do you teach/master Neurosurgicalテクニック?脳波編(第4回) 正常波形を見極める!!

江夏 怜

脳神経外科速報 ( (株)メディカ出版 )  31 ( 6 ) 1002 - 1010  2021.11

Effects of polarity of bipolar sensorimotor direct cortical stimulation on intraoperative motor evoked potentials.

Shoto Yamada, Rei Enatsu, Yusuke Kimura, Katsuya Komatsu, Yukinori Akiyama, Takeshi Mikami, Satoko Ochi, Nobuhiro Mikuni

Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology   132 ( 10 ) 2351 - 2356  2021.10  [International journal]

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OBJECTIVE: The present study investigated the effects of the stimulus polarity and location of motor evoked potential (MEP) to establish a stimulation protocol. METHODS: Nineteen patients who intraoperatively underwent MEP in bipolar direct cortical stimulation were enrolled in the present study. Somatosensory evoked potentials (SEP) of the contralateral median nerve stimulation were recorded to determine stimulation sites. MEP was performed under two settings in all patients: 1. Anodal bipolar stimulation: an anode on the precentral gyrus and a cathode on the postcentral gyrus, 2. Cathodal bipolar stimulation: a cathode on the precentral gyrus and an anode on the postcentral gyrus. MEP amplitudes and the coefficient of variation (CV) at a stimulation intensity of 25 mA and the thresholds of induced MEP were compared between the two settings. RESULTS: An electrical stimulation at 25 mA induced a significantly higher amplitude in cathodal bipolar stimulation than in anodal bipolar stimulation. Cathodal bipolar stimulation also showed significantly lower thresholds than anodal stimulation. CV did not significantly differ between the two groups. CONCLUSIONS: These results indicate that cathodal bipolar stimulation is superior to anodal bipolar stimulation for intraoperative MEP monitoring. SIGNIFICANCE: MEP in cathodal bipolar cortical stimulation may be used in a safe and useful evaluation method of motor fiber damage that combines sensitivity and specificity.

DOI PubMed

遺伝的素因をもつ薬剤抵抗性てんかんに対する迷走神経刺激療法の長期的効果 Naチャネル異常の確定例の症例報告

越智 さと子, 菅野 彩, 江夏 怜, 三國 信啓, 福村 忍, 横山 茂, 櫻井 高太郎, 白石 秀明

臨床神経生理学 ( (一社)日本臨床神経生理学会 )  49 ( 5 ) 450 - 450  2021.10

頭蓋内電極による低侵襲脳機能マッピング:発作や後発射はもうご免 皮質脳波による機能マッピング

江夏 怜, 菅野 彩, 在原 正泰, 玉田 智晃, 三國 信啓

臨床神経生理学 ( (一社)日本臨床神経生理学会 )  49 ( 5 ) 337 - 337  2021.10

How do you teach/master Neurosurgicalテクニック?脳波編(第3回) デジタル脳波計を使いこなす!!

江夏 怜

脳神経外科速報 ( (株)メディカ出版 )  31 ( 5 ) 840 - 848  2021.09

運動亢進発作の発作焦点と皮質領域のネットワークの検討

笹川 彩佳, 江夏 怜, 栗原 伴佳, 在原 正泰, 平野 司, 越智 さと子, 三國 信啓

てんかん研究 ( (一社)日本てんかん学会 )  39 ( 2 ) 310 - 310  2021.07

How do you teach/master Neurosurgicalテクニック?脳波編(第2回) 脳波測定の基礎

江夏 怜

脳神経外科速報 ( (株)メディカ出版 )  31 ( 4 ) 676 - 683  2021.07

Pitfalls of Commonly Used Ischemic and Dementia Models Due to Early Seizure by Carotid Ligation.

Tsukasa Hirano, Takeshi Mikami, Shoto Yamada, Hiroshi Nagahama, Rei Enatsu, Satoshi Ookawa, Yukinori Akiyama, Nobuhiro Mikuni

Neurologia medico-chirurgica   61 ( 5 ) 312 - 320  2021.05  [Domestic journal]

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While the bilateral common carotid artery (CCA) ligation model is widely used in cerebrovascular disease and dementia studies, it can frequently cause seizures. We examined the validity of seizure as an experimental model of ischemia. Eight-week-old male Wistar and Sprague-Dawley (SD) rats were implanted with electrocorticography (ECoG) electrodes and bilateral CCA ligation was performed and compared to the sham groups. ECoG monitoring was used to confirm the seizure discharge and count the number of spikes in the interictal phase 2 h after ligation, followed by power spectral analysis. Magnetic resonance imaging (MRI) was performed 6 h after bilateral CCA ligation to assess fractional anisotropy (FA), apparent diffusion coefficient (ADC), and cerebral blood flow (CBF) values. Magnetic resonance spectroscopy (MRS) was also performed and the ischemic parameters and electrophysiological changes were compared. The Wistar rat group had significantly higher mortality, frequency of seizures, incidence of non-convulsive seizures, and number of spikes in the interictal period compared to those in the SD rat group. Power spectral analysis showed increased power in the delta band in both Wistar and SD rat groups. MRI, after CCA ligation, showed significantly lower ADC values, lower glutamine and glutamate levels, and higher lactate values in Wistar rats, although there was no difference in FA values. Metabolic and electrophysiological changes after CCA ligation differed according to the rat strain. Wistar rats were prone to increased lactate and decreased glutamine and glutamate levels and the development of status epilepticus. Seizures can affect the results of ischemic experiments.

DOI PubMed

A case of paroxysmal kinesigenic dyskinesia suspected to be reflex epilepsy.

Chie Nakayama-Kamada, Rei Enatsu, Shinobu Fukumura, Tomoyoshi Kuribara, Satoko Ochi, Nobuhiro Mikuni

Nagoya journal of medical science   83 ( 2 ) 361 - 365  2021.05  [Domestic journal]

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An 11-year-old male patient developed weakness or right arm elevation after sudden movement at the age of eight. Reflex epilepsy was initially suspected; however, magnetic resonance imaging and electroencephalography (EEG) revealed no abnormality. Video-EEG monitoring was performed, but no change was noted during attacks of weakness. He was diagnosed with paroxysmal kinesigenic dyskinesia (PKD) and carbamazepine has stopped his attacks. PKD is a rare neurological disorder characterized by brief attacks of involuntary movement triggered by sudden voluntary movements, which may be confused with reflex epilepsy. PKD should be considered as a differential diagnosis of reflex epilepsy.

DOI PubMed

How do you teach/master Neurosurgicalテクニック?脳波編(第1回) 脳波ってなんだ?

江夏 怜

脳神経外科速報 ( (株)メディカ出版 )  31 ( 3 ) 478 - 485  2021.05

術中運動誘発電位に対する皮質双極刺激における刺激極性の影響

山田 奨人, 江夏 怜, 橋本 修一, 室橋 高男

日本臨床工学技士会会誌 ( (公社)日本臨床工学技士会 )  ( 72 ) 148 - 148  2021.04

Eye Movement Network Originating from Frontal Eye Field: Electric Cortical Stimulation and Diffusion Tensor Imaging.

Yusuke Kimura, Rei Enatsu, Rintaro Yokoyama, Hime Suzuki, Ayaka Sasagawa, Tsukasa Hirano, Masayasu Arihara, Tomoyoshi Kuribara, Satoko Ochi, Nobuhiro Mikuni

Neurologia medico-chirurgica   61 ( 3 ) 219 - 227  2021.03  [Domestic journal]

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This study investigated the networks originating from frontal eye fields (FEFs) using electric cortical stimulation and diffusion tensor imaging (DTI). Seven patients with intractable focal epilepsy, in which FEFs were identified by electrical cortical stimulation, were enrolled in this study. Electric stimulation at 50 Hz was applied to the electrodes for functional mapping. DTI was used to identify the subcortical fibers originating from the FEFs with two regions of interests (ROIs) in the FEF and contralateral paramedian pontine reticular formation (PPRF). FEFs were found in the superior precentral sulcus (pre-CS) in six patients and superior frontal gyrus (SFG) in three patients. DTI detected fibers connecting FEFs and contralateral PPRFs, passing within the internal capsule. The fibers were located close to the lateral antero-superior border of the subthalamic nucleus (STN) and medial posterior border of the globus pallidus internus (GPi). This study found the characteristic subcortical networks of the FEF. These tracts should be noted to prevent complications of deep brain stimulation (DBS) of the STN or GPi.

DOI PubMed

振戦型パーキンソン病患者の小脳視床路DBSの耐性とcycling modeの有用性

北川 まゆみ, 江夏 怜, 三國 信啓

パーキンソン病・運動障害疾患コングレスプログラム・抄録集 ( Movement Disorder Society of Japan (MDSJ) )  14回   85 - 85  2021.02

Preoperative Prediction of Communication Difficulties during Awake Craniotomy in Glioma Patients: A Retrospective Evaluation of 136 Cases at a Single Institution.

Tomoyoshi Kuribara, Yukinori Akiyama, Takeshi Mikami, Yusuke Kimura, Katsuya Komatsu, Rei Enatsu, Yasuyuki Tokinaga, Nobuhiro Mikuni

Neurologia medico-chirurgica   61 ( 1 ) 21 - 32  2021.01  [Domestic journal]

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Awake craniotomy has been widely performed in patients with glioma in eloquent areas to minimize postoperative brain dysfunction. However, neurological examination in awake craniotomy is sometimes problematic due to communication difficulties during the intraoperative awake period. We evaluated preoperative predictors of these difficulties in awake craniotomy for patients with glioma. In all, 136 patients with glioma who underwent awake craniotomy at our institution between January 2012 and January 2020 were retrospectively evaluated. Patients were divided into two groups (appropriately awake group and inappropriately awake group) depending on their state during the intraoperative awake period, and the relationship between communication difficulties in awake craniotomy and both clinical and radiological characteristics were assessed. The appropriately awake group included 110 patients, and the inappropriately awake group included 26 patients. Reasons for inclusion in the inappropriately awake group were insufficient wakefulness in 15 patients, restless state in 6, and intraoperative seizures in 5. In multivariate analysis, the likelihood of being inappropriately awake was inversely correlated with preoperative seizures (odds ratio [OR], 0.23; 95% confidence interval [CI], 0.06-0.89; p = 0.033) and positively correlated with left-sided lesions (OR, 7.31; 95% CI, 1.54-34.62; p = 0.012). Both lack of preoperative seizures and left-sided lesions were identified as risk factors for intraoperative difficulties in awake craniotomy for patients with glioma. Understanding these risk factors may lead to more appropriate determination of eligibility for awake craniotomy.

DOI PubMed

Preoperatively estimated graft flow rate contributes to the improvement of hemodynamics in revascularization for Moyamoya disease.

Tomoyoshi Kuribara, Takeshi Mikami, Katsuya Komatsu, Yusuke Kimura, Sangnyon Kim, Kei Miyata, Yukinori Akiyama, Rei Enatsu, Toru Hirano, Nobuhiro Mikuni

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association   30 ( 1 ) 105450 - 105450  2021.01  [International journal]

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OBJECTIVES: Superficial temporal artery (STA)-middle cerebral artery (MCA) bypass operation is an effective treatment for patients with Moyamoya disease, and the hemodynamic parameters are reported to be improved after operation. However, there is no report concerning hemodynamic changes from the viewpoint of the preoperative anatomical structure of grafts. In this study, we evaluated the correlation between the preoperatively estimated blood flow of the graft obtained through image-based computational fluid dynamics (CFD) analysis and the hemodynamic changes in the acute phase after revascularization. MATERIALS AND METHODS: A total of 30 hemispheric sides of 23 patients were examined. The blood flow, that is, flow rate (FR) of the STA branches that were anastomosed to the MCA was evaluated using CFD analysis based on computed tomography (CT) angiography imaging data. The correlations between the FR and the hemodynamic changes in the acute phase after revascularization obtained through CT perfusion were assessed. RESULTS: The preoperatively estimated FR of the graft was moderately correlated with the changes in the mean transit time significantly and weakly correlated with those in the cerebral blood flow and cerebral blood volume. In addition, the FR was strongly correlated with age and the diameter of the STA from the origin to the bifurcation. CONCLUSION: The preoperatively estimated FR of the graft obtained through image-based CFD analysis contributed to the improvement of the mean transit time after revascularization. Because the FR of the graft was associated with the diameter of the STA, the size of the STA might be an important factor in postoperative hemodynamic changes. This might lead to the risk assessment of acute drastic hemodynamic changes as cerebral hyperperfusion, and consequently, better surgical outcomes might be expected.

DOI PubMed

てんかん地域診療体制整備事業に絡めて "道東唯一の常勤専門医"にできること

菅野 彩, 今泉 俊雄, 江夏 怜, 越智 さと子, 三國 信啓

てんかん研究 ( (一社)日本てんかん学会 )  38 ( 3 ) 221 - 222  2021.01

「1秒以上かつ1サイクルの10%以上のOFF」のcycling modeがtremor reboundと耐性の抑制に有効だったbenign tremulous parkinsonismの3例

北川 まゆみ, 江夏 怜, 三國 信啓

臨床神経学 ( (一社)日本神経学会 )  61 ( 1 ) 54 - 54  2021.01

VNS-Aspire SR 50 cases分析からみる治療効果とVNS道内治療地域連携上の課題

越智 さと子, 菅野 彩, 平野 司, 江夏 怜, 三國 信啓

てんかん研究 ( (一社)日本てんかん学会 )  38 ( 3 ) 222 - 222  2021.01

Target Selection of Directional Lead in Patients with Parkinson's Disease.

Ayaka Sasagawa, Rei Enatsu, Mayumi Kitagawa, Takeshi Mikami, Chie Nakayama-Kamada, Tomoyoshi Kuribara, Tsukasa Hirano, Masayasu Arihara, Nobuhiro Mikuni

Neurologia medico-chirurgica   60 ( 12 ) 622 - 628  2020.12  [Domestic journal]

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Several structures including subthalamic nucleus (STN), the caudal zona incerta (cZI), the prelemniscal radiation (Raprl), and the thalamic ventral intermediate nucleus (Vim) have been reported to be useful for improving symptoms of Parkinson's disease (PD). However, the effect of each target is still unclear. Therefore, we investigated each structure's effects and adverse effects using a directional lead implanted in the posterior STN adjacent to the cZI and Raprl in two patients with tremor-dominant PD. In Case 1, maximal reduction of tremor was obtained by stimulation toward the Vim, and stimulation toward the thalamic reticular nucleus (TRN) reduced verbal fluency, but did not induce dysarthria. In Case 2, maximal reduction of tremor was obtained by stimulation toward the dorsal STN and Raprl. Maximal reduction of rigidity was achieved by stimulation toward the dorsal STN, Raprl, and cZI. Bradykiensia was improved by stimulation in all directions, but dyskinesia and dysarthria were evoked by stimulation toward the dorsal STN and cZI. The directional lead may elucidate the stimulation effect of each structure and broaden target selection depending on patients' symptoms and adverse effects.

DOI PubMed

Effect of Cycling Thalamosubthalamic Stimulation on Tremor Habituation and Rebound in Parkinson Disease.

Rei Enatsu, Mayumi Kitagawa, Takashi Morishita, Ayaka Sasagawa, Tomoyoshi Kuribara, Tsukasa Hirano, Masayasu Arihara, Takeshi Mikami, Nobuhiro Mikuni

World neurosurgery   144   64 - 67  2020.12  [International journal]

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BACKGROUND: Deep brain stimulation is an effective treatment for severe tremor in essential tremor and Parkinson disease (PD). However, progressive loss of the beneficial effects of deep brain stimulation may occur due to several factors. CASE DESCRIPTION: We assessed the effects of different temporal patterns of cycling stimulation in the posterior subthalamic area, subthalamic nucleus, and the ventral intermediate nucleus of the thalamus in 3 PD patients with early decline of tremor suppression associated with severe tremor rebound. CONCLUSIONS: Certain temporal patterns of cycling (10 seconds on/1 second off or 30 seconds on/5 seconds off, soft start off) were useful for treating tremor habituation and rebound and showed long-term tremor suppression. Cycling stimulation may prevent tremor habituation in PD patients with severe tremor rebound.

DOI PubMed